A joint effort to reach Mali's malnourished children

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A partnership between the European Commission Humanitarian Aid Department and UNICEF aims to help communities treat malnutrition and provide a more nutritious diet for their children.

BANCOCOUROU, Mali, 14 May 14 – Malaria is always bad news. But the raging fever it brought may have been a life saver for 2-year-old Sogona. “The fever meant I knew my daughter was sick,” says Aminata Kanté. “I heard at the mosque where I go to pray that some doctors were coming. So I brought her along. That is how we found out she also is suffering from malnutrition.”

On a routine visit to Bancocourou, 35 km from Bamako, Mali's capital, health workers have come to screen children for malnutrition, share food tips, and even stir the pot with village mothers. The visit is made possible thanks to funding from the European Commission Humanitarian Aid Department (ECHO), with health extension workers from UNICEF partner International Rescue Committee (IRC).

Théophane Traoré, UNICEF Mali Nutrition Officer, says the ECHO-UNICEF partnership is crucial to reaching malnourished children early. “This partnership should be multiplied and strengthened across the country,” he says.

Making a difference

In the south of Mali, ECHO funding enables UNICEF to purchase and deliver medicines and therapeutic food. ECHO also funds an ambulance to transport the sickest children and their mothers for emergency care. Mr. Traoré adds: ''ECHO's support makes a real difference to preventing relapses and improving the quality of the service.''

Mali has a high rate of acute malnutrition, and the region of Koulikoro, where Bancocourou is situated, is one of the worst hit. Sogona's case is spotted after she and her mother spend a morning attending a cooking workshop and information session. A recipe is shared and the mothers prepare it together in a big pot. Called laro, it is a porridge made with essential – and locally available – ingredients: fish or groundnuts for bulk, maize or wheat flour for energy, and onions, tomatoes and salt. The recipe includes the right combination of foods to provide a highly nutritious meal. Enough Laro is prepared so that each family can take home a bowl.

Then, with dozens of other Bancocourou children, Sogona lines up under a tree to be weighed, measured for height and have the circumference of her upper arm checked. The special measuring tape is colour-graded green, yellow and red. Mr. Traoré wraps it round the 2-year-old's arm and pulls it closed: Sogona's reading – 110mm – takes her into the red zone.

“After the information session and the recipe workshop, we were able to evaluate the nutritional condition of 210 children. Among them, we found 21 whose arm measured less than 125 mm,” Mr. Traoré says. “Among those, seven, including Sogona, had a reading below 115 mm, which tells us they are cases of severe acute malnutrition, which need to be referred immediately to the nearest health centre.”

Therapeutic treatment

The next day, Sogona's father, fisherman Sébou Doumbia, climbs on his motorbike and drives his wife and daughter to the health centre, 21 km away. “When we got here, Sogona was undressed and weighed, and I was given malaria medicine and Plumpy’nut for her. All the mothers here were given soap and we were told to wash our hands before giving Plumpy’ nut to our child,” says Aminata.

Mr. Traoré is optimistic about Sogoma's case. Although though she has malaria, weighs only 8.5 kg and her arm measures 110 mm, she has responded well to the appetite test. “That is when we give the children a sachet of therapeutic food and watch them eat it,” he says. “If they finish the sachet within 45 minutes, we generally feel confident to continue treatment on an outpatient basis. Sogona will be allowed to go home with the medication she needs and a supply of Plumpy’nut to be taken three times a day. In a week's time we want her to visit the health centre again to help her build up a healthy weight.''

Others are not so lucky. At a nearby referral centre, Mr. Traoré sees children who have been admitted because their malnutrition has reached critical stages. They include cases of emaciation, marasmus and kwashiorkor, a form of malnutrition linked to lack of sufficient protein.

Emaciated and suffering from a respiratory infection, 1-year-old Aminata Kamara was admitted five days ago with marasmus, malnutrition caused by rapid deterioration in nutritional status and characterized by severe wasting of fat a muscle. Her mother, Mariam, says it is the first time one of her three children has been diagnosed with malnutrition.

Before being brought to the referral centre in the ECHO-funded ambulance, mother and daughter had sought the advice of a herbalist, who administered a traditional paste of crushed, wild fruit to the child's forehead. Medical staff see no harm in such treatment, but they administer therapeutic milk and injections of antibiotics.

“It is a great relief to be here,” says Ms. Kamara. “My daughter was refusing my breast milk. Now she is being treated, and I am given meals also. Everything is free, and I am no longer worried.”

Root causes

Mr. Traoré says children such as these, with severe acute malnutrition and associated infections, face two tiers of treatment. “Typically, they will need to be treated with antibiotics for a respiratory infection, for example. They will also require therapeutic milk to give them back some energy and restore the metabolism which has become confused. Only after that stage does it become possible to start working on their weight with the gradual introduction of Plumpy’ nut,'' he says.

As Mr. Traoré explains, there are three main causes of malnutrition here: the lack of food security, limited access to health services, and habits that are sometimes harmful, such as not breastfeeding newborns for the first six months of life. “It is not easy tackling the root causes, which are linked to poverty and the climate, and require structural change. But what we can do is inform mothers of the best approaches we know to maximize their children's chances,” he says.

Back in Bancocourou, the Doumbia family have settled down in an outside porch to make a new nutritional start. Sogona wants her father to feed her. The fisherman reaches for the laro – the porridge made at yesterday's cooking session. Her mother pledges to prepare it regularly. “I am not used to preparing this recipe,” she says. “I knew another one using different ingredients. But I am going to switch to Laro to ensure my daughter puts on weight and never suffers from malnutrition again.”